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by
Carol Tavris
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October 22 - November 3, 2023
over 90 percent of women currently diagnosed with early breast cancer will be cured, and most will not need disfiguring mastectomies or chemotherapy.
Because estrogen replacement therapy (ERT) alone is associated with an increased risk of endometrial cancer (cancer of the lining of the uterus), women who still have a uterus are given hormone replacement therapy (HRT)—estrogen plus progesterone—which provides the benefits of estrogen without the increased risk of endometrial cancer.
Estrogen not only successfully controlled menopausal symptoms in most women but also significantly reduced the risks of heart disease, hip fractures, colon cancer, and Alzheimer’s.
a 50 percent decrease in the risk of developing or dying of colon cancer. And a USC study reported a 35 percent decrease in the risk of Alzheimer’s. Among women with no history of breast cancer, studies found that estrogen did not increase the risk of developing it, even among women who had been taking estrogen for ten to fifteen years. Most remarkable, women taking estrogen were living longer than women who were not taking hormones. A 1997 report in the Journal of the American Medical Association stated that “HRT should increase life expectancy for nearly all postmenopausal women by up to 3
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In her 1995 book A New Prescription for Women’s Health: Getting the Best Medical Care in a Man’s World, Bernadine Healy, a cardiologist and the first (and thus far only) female director of the National Institutes of Health (NIH), observed that many of the major risks that women face as they age—heart disease, stroke, osteoporosis, and Alzheimer’s disease—“are or may well be reduced by hormone replacement therapy.” As a result of that data, she wrote, when she hit menopause, she planned to begin HRT “without a blink”:
estrogen were an important cause of breast cancer, we would expect rates of breast cancer to decline after menopause, when estrogen levels naturally diminish. Instead, breast cancer rates increase.
Ayerst began to market Premarin in the 1950s as a treatment for menopausal symptoms, a campaign greatly enhanced in the 1960s by the publication of Feminine Forever, a hyperventilating bestseller written by New York gynecologist Robert Wilson.3 The book promised youth, beauty, and a full sex life for menopausal women through the use of estrogen. Wilson’s son Ronald later told reporter Gina Kolata at the New York Times that Ayerst had paid all of his father’s expenses for writing the book and financed his father’s organization, the Wilson Research Foundation.
In 1992, the first randomized, double-blind, placebo-controlled
by the year 2000, major journals, research institutions, and leading oncologists were coming to the consensus that estrogen did not increase the risk of breast cancer.
In the WHI’s press release, Anderson justified her statistical decisions this way: “Because breast cancer is so serious an event, we set the bar lower to monitor for it. We pre-specified that the change in cancer rates did not have to be that large to warrant stopping the trial. And the trial was stopped at the first clear indication of increased risk.” In other words: We set the bar low enough to monitor for nonsignificant results if we could squeak out any.
2010 the WHI authors published yet another article, this one claiming that women who had been on HRT suffered more deaths from breast cancer (2.6 versus 1.3 deaths per 10,000 women per year) than those who had been on a placebo—again, a difference that was not statistically significant.
The WHI was heralded as being truly representative of women during and after menopause, and the WHI investigators repeatedly stated that all of the women they recruited were healthy at the outset of the study, but neither assertion was true. Fully 35 percent of the women were considerably overweight, and another 34 percent were obese; nearly 36 percent were being treated for high blood pressure; nearly half were either current or past cigarette smokers.39 Moreover, the median age of participants was
sixty-three, long past the onset of menopause. Therefore, there is no credible reason for generalizing from the results of this study to the entire population of postmenopausal women—even though that was precisely...
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WHI, told Parker-Pope that the WHI “was intentionally going for ‘high impact’ when it called the press conference,” because they didn’t want their news to “get lost in the shuffle of daily news events,” especially when their goal “was to shake up the medical establishment and change the thinking about hormones.”
the administration of estrogen has been shown to have beneficial effects even in women with advanced breast cancer.
I see major depression and generalized anxiety disorder, ruined sexual and emotional connection with spouses, disintegrating marriages and fractured families as a result. Of course, the depletion of estrogen in menopause is not the single cause of these problems, but I’m certain it plays a predominant role in the abrupt loss of these women’s (and their families’) quality of life after menopause.
In a large, yearlong study that compared menopausal women on hormones with those who were on a placebo, most of the women gained some weight—but the hormone group gained less than the placebo group. And in the Women’s Health Initiative, a higher proportion of those on HRT lost weight compared to the women on placebo.
Why is replacement a bad word when it refers to menopause hormones but not a bad word when it refers to, say, replacing thyroid hormones if the thyroid gland is removed?
As far as we know, the only animal besides humans that goes through menopause and lives for many years thereafter is the whale, making this phenomenon something of an evolutionary mystery.
The WISDOM study, an acronym for the Women’s International Study of Long-Duration Oestrogen After the Menopause, was a randomized, placebo-controlled trial of 3,721 postmenopausal women in Australia, New Zealand, and the United Kingdom.
suffering from depressive episodes received four to twelve weeks of estrogen or placebo found a 60 to 75 percent improvement in the estrogen group versus a 20 to 30 percent improvement for women given placebo.
Ten years after their original paper, in a follow-up study published in 2012, the WHI finally admitted that estrogen did, in fact, significantly reduce vasomotor symptoms such as light-headedness, dizziness, and hot flashes and that those symptoms recurred as soon as the women stopped taking estrogen.
We won’t even discuss the ever-popular all-purpose pabulum about “individualized lifestyle modifications and non-pharmacologic therapies” for treating symptoms, such as these recommendations from the Journal of Clinical Endocrinology and Metabolism: women should stop smoking, lose weight, drink less alcohol, take vitamin D and calcium, eat a healthy diet, use vaginal lubricants, and get regular physical activity.
who regard HRT as the “most effective prescription medicine for menopause,” suggest that women who don’t want to take hormones might consider “Omega 3s for brain function, vitamin D for bones, Starflower Oil for breast tenderness. Vitamin E oil can be used for vaginal dryness.”39 Countless popular books of menopause advice recommend these herbal products, a multibillion-dollar industry, but study after study finds that none of them reduces menopausal symptoms any more than placebos
Erika Schwartz, Kent Holtorf, and David Brownstein. The essay began with an uncritical acceptance of the WHI’s findings, claiming that “hormone-replacement therapy has become a textbook example of how special interests, a confused medical establishment, and opportunists can combine to complicate the
An informal focus group of twenty-one women who were using or had used compounded bioidenticals were asked about their reasons for avoiding conventional HRT. They mentioned fear of its risks, an aversion to “mares’ urine,” and, most of all, an “overarching distrust of a medical system perceived as dismissive of their concerns and overly reliant on pharmaceuticals.”
In Making Sense of Science, Cornelia Dean, a science writer for the New York Times, dismissed the findings of the WHI as concisely as the little boy who announced that the emperor was naked: “The study enrolled women whose mean age was 63. In other words, they had been a decade or more past menopause. What the study demonstrated, it seemed, was
that starting replacement therapy ten years after menopause offered little benefit.”
After having a hip fracture, women lost an average of 3.75 years of life.
Women fear dying of breast cancer, but current estimates suggest that that risk and the lifetime risk of dying of the complications of a hip fracture are about the same.
some physicians began to conflate osteoporosis and osteomalacia, and the subsequent blurring of the two conditions led to the widespread but incorrect
belief that if women just took enough calcium and vitamin D, they could stave off osteoporosis.
Although calcium is crucial for the development of strong bones in children and adolescents, once bones are formed, additional calcium neither prevents nor treats bone loss.
When women go off estrogen, the risk of hip fractures rapidly increases, and within six years it is where it would have been had they never taken hormones at all.
Grob showed how during the 1950s and 1960s, as more and more people were living to the age of sixty-five and beyond, older people “emerged as a self-conscious group with distinct interests,” one of which was a vehement rejection of viewing old age solely as a gloomy time of infirmity and disability.
While exercise may improve bone strength and resistance to fracture in premenopausal women, however, it does not improve bone strength or resistance to fracture among postmenopausal women who are not on HRT.
There is growing evidence that taking bisphosphonates over the long term may impair the bones’ ability to repair microcracks, thereby leading to increased skeletal fragility.
with a higher risk of clinical fracture than two years of use.
Currently, ERT or HRT is the most effective intervention with the fewest unpleasant or dire side effects for preventing or diminishing the development of osteoporosis.
Alzheimer’s patients typically survive from four to ten years after the onset of the illness, the cost of their care to families and society is immense, financially as well as emotionally. With about five and a half million Americans living with Alzheimer’s, the total cost for their health care, including long-term care and hospice services, has surpassed the quarter-trillion mark: $259 billion.4 (For comparison, that is about $100 billion more than the cost of care for people with all cancers combined.)
The FDA has approved some drugs to ease the symptoms of Alzheimer’s dementia: donepezil (Aricept), mirtazapine (Remeron), tacrine (Cognex, which was discontinued in the United States because of its link with acute liver damage), galantamine (Reminyl or Razadyne), rivastigmine (Exelon), memantine (Ebixa or Namenda), and Namzaric, which combines donepezil with memantine. None of them slows or stops the progression of Alzheimer’s disease.
Decades of research have demonstrated the role of estrogen in helping to preserve the cognitive ability of postmenopausal
This was especially curious because they began their first paper with a litany of studies demonstrating estrogen’s protective effects on the brain, including its ability to reduce the loss of neurons, improve cerebral blood flow, and modulate expression of the APOE gene.16 Eventually, the WHI investigators conceded that their study was not designed to determine whether women who began taking estrogen at the time of menopause would have a lower risk of the onset of cognitive decline or Alzheimer’s disease a decade or two later.
One of the most astonishing advances in brain science has been the discovery of the human brain’s neuroplasticity, the fact that neurons can form new connections throughout a person’s life, sometimes compensating for injury or disease. Laboratory studies have suggested that estrogen can enhance neuroplasticity by modifying the structure of nerve cells in the brain and altering the way they communicate
with one another. The real-life applications of this research remain uncertain, but we want to describe here some of the abundant evidence that estrogen, administered when menopause begins, may prevent, or at least delay, the onset of dementia, including dementia resulting from Alzheimer’s disease.
Estrogen affects all of these aspects of brain anatomy, both directly and indirectly. It stimulates the growth of neurons and synapses, and it increases plasticity, the brain’s remarkable ability to adapt and change.21 It turns out that estrogen receptors are located throughout the brain, especially in the hippocampus and other areas involved in learning and memory.22 Neuroscientists such as Elizabeth Gould, who is now at the Princeton Neuroscience Institute, have found that estrogen affects the brain mechanisms involved in memory, aging, and degenerative diseases
In one early study, for example, Gould and her colleagues found that removing the ovaries of adult female rats—which caused levels of circulating estrogen to plummet—resulted in a profound decrease in the number of dendrites on neurons in the rats’ hippocampi. When they gave the rats estrogen, with or without progesterone, after removing the ovaries, this decrease did not occur.
few years later, Sherwin and her colleague Stuart Phillips conducted a study of otherwise healthy women who had had hysterectomies and removal of their ovaries for benign disease. The women took a battery of memory tests before
surgery and again two months later after receiving injections of either estrogen or placebo. Those receiving estrogen either stayed at their pre-surgery cognitive level or, on one test, actually improved; those on placebo did worse on most of the verbal tests.
their results in the Annals of the New York Academy of Sciences under the title “Pitfalls of the Women’s Health Initiative.” Their reanalysis controlled for detection bias and the statistical manipulations that had appeared to indicate danger—and the supposed increased risk of stroke vanished. Far from supporting the WHI’s decision to stop the study, Mastorakos and his colleagues concluded this: “A closer look at the results of the WHI trial reveals that the use of HRT for 5 years should not be considered deleterious for the appearance of breast cancer, cardiovascular diseases, strokes, and
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